Efficiency of Intravenous Thrombolytic Therapy in Isolated Middle Cerebral Artery Occlusions: A Computed Tomography Angiography Study

Objective: We aimed to evaluate the outcomes of two groups of patients with acute ischemic stroke who were treated with intravenous recombinant tissue-plasminogen activator (IV rt-PA); those with isolated middle cerebral artery (MCA) occlusion and those without any large vessel occlusion. Materials and Methods: Data of patients treated with IV rt-PA within 4.5 hours of symptom onset between March 2015 and January 2017 were retrospectively analyzed. Patients were divided into two groups; those with isolated MCA occlusion and those with no large vessel occlusion. Large vessel occlusion was detected with contrast-enhanced computed tomography angiography performed before IV rt-PA. Additionally, demographic and clinical data of the patients were analyzed. The clinical outcomes of the patients were determined using the modified Rankin Scale (mRS) score at 3 months after treatment. Results: A total of 69 patients were included in the study. Isolated MCA occlusion was observed in 28 (40.6%) patients. The rate of very good outcome (mRS 0-1) was 46.4%, whereas the rate of poor outcome (mRS 3-6) was 42.9% in the group with isolated MCA occlusion. Moreover, in the other group, the rate of very good outcome and poor outcome were 65.9% and 26.8%, respectively. Conclusion: In acute ischemic stroke with isolated MCA occlusion, due to the favorable outcomes of the patients, IV rt-PA continues to be the best treatment option in cases where endovascular treatment options cannot be performed and it should be applied by physicians in appropriate cases without delay.